POS0918 TARGET-CONTROLLED INFUSION (TCI) WITH PROPOFOL AND REMIFENTANIL FOR PROCEDURAL SEDATION AND ANALGESIA (PSA) IN PATIENTS WITH SYSTEMIC SCLEROSIS (SSC) UNDERGOING AUTOLOGOUS FAT GRAFTING PROCEDURES
Authors: R. Feminò, A. Spinella, A. Carratta, M. De Pinto, M. Starnoni, E. Bertellini, G. De Santis, C. Salvarani, D. Giuggioli
Journal: Annals of the Rheumatic Diseases (2022)

Background Systemic sclerosis-SSc is an autoimmune disease characterized by vascular alterations and fibrosis. Difficult airway management, peripheral venous access and systemic comorbidities are often concomitant. Therefore, performing general anesthesia or moderate to deep sedation in these patients can be challenging. A high psychiatric burden is also common. These conditions, in association with a history of chronic pain, make even the local anesthesia procedure less effective than usual. Oral/digital autologous fat grafting approaches may improve aesthetic/functional aspects in SSc but the surgical procedure itself is painful and requires proper sedation. Target-Controlled Infusion with propofol (hypnotic) and remifentanil (opioid) is a well consolidated anesthesia technique and could be the best Procedure Sedation and Analgesia strategy to tolerate these interventions. Objectives Developing a new Procedural Sedation and Analgesia-PSA protocol to obtain moderate to deep sedation in Day Surgery environment to allow complete analgesia, amnesia and safe discharge in SSc patients undergoing autologous fat grafting procedures. Methods Eighteen-18 SSc patients referring to the Scleroderma Unit of our University Hospital were recruited for oral/digital autologous fat grafting procedures between July and December 2021. A proper anaesthesiology schedule was assessed by an expert anesthesiologist of the team. After informed consent acquisition, patients were monitored with ECG/SpO2/Non Invasive Blood Pressure-NIBP. A peripheral intra-venous line with an ultrasound probe was placed if needed and TCI was started. Patients were maintained in spontaneous breathing and supplementary oxygen (4lt/min) with a rhinopharyngeal cannula. The use of TCI pumps for the delivery of propofol and remifentanil allowed trained anesthesiologists to control and adjust the level of sedation and analgesia. The synergy between both propofol and remifentanil is well known, main risk for such technique is to oversedate patients resulting in respiratory depression and hypotension. Bispectral Index-BIS was used to monitor sedation level starting from 60-80, then tailoring the infusion according to surgical needs. TCI was stopped at the end of surgery. Vital parameters were registered every 5 minutes and potential complications were monitored (hypotension=PAS&lt;30% of basal line, hypoxia=SpO2&lt;92%). Paracetamol 1g/ketorolac 15mg were administered for postoperative analgesia. A simplified satisfaction questionnaire based on LPPSq was also administered before discharge. Results All subjects have successfully undergone surgery and no hospitalization after the procedures was needed. A peripheral blood desaturation (SpO2&lt;90%) was registered as main complication in 4 subjects, promptly relieved through nasal cannula replacement. One patient registered transient hypotension (decrease in systolic blood pressure&gt;30% below baseline) without vasoactive drugs need. Mean time to recovery of consciousness was 6.3 minutes (range 3-11). Two patients experienced transient pain and nausea, 1 itchiness, and 1 subjective difficulties in breathing/talking some minutes after the surgery with spontaneous resolution. All patients gave their consent to perform the same approach in the future. Conclusion TCI of propofol and remifentanil might be successfully used to ensure procedural sedation and analgesia in SSc surgical settings in presence of a skilled anesthesiologist. Further data are required to assess the incidence of possible major complications and patients’ satisfaction. Disclosure of Interests None declared